America's fire service has a long history of serving the public. So much so that in the last decade we have seen the citizen renamed the customer, but while the terminology has changed, the mission has not — the fire service remains the safety net and one of the most trusted government services. Progressive fire chiefs now operate Web sites with links to customer feedback forms for their organizations. Phoenix Chief Alan Brunacini's Essentials of Fire Department Customer Service is now required reading for many fire department company officer programs.

Many of the details of a good customer service program have been learned from the private ambulance industry's Fortune 500 companies. These organizations have challenged the fire service over the past 20 years to come up with more complete customer service programs. Do the fire service's customer service efforts stand up to our reputation and earn the public's trust?

The rules of business customer service can be applied to public safety. One is that the average business never hears from 96% of its unhappy customers. I think most paramedics would agree that we rarely see a customer visit the station and convey their thanks or gratitude. Most people don't feel comfortable coming to the fire station, so management must solicit that information. For every compliant received there are 26 customers with problems who haven't complained to your organization. Six of those will have very serious problems with your organization's service delivery. The average unhappy customer tells up to 10 other people about the poor service they experienced. Thirteen of those customers who have a problem with an organization's service will go on to tell more than 20 people.

Compare this to a person who experiences good service and will tell between three to five other people about their experience. If a complaint is resolved, 50-70% will change their opinion of the organization, and if the complaint is solved swiftly 95% will return to do business with an organization. Most of these statistics are being applied to public safety from the business world simply because the fire service has not collected statistics on satisfaction ratings, complaints, or good- to excellent experiences with their service delivery.

Supporting the troops is just as important as supporting the needs of Brunacini's infamous Mrs. Smith in his customer service manual. Chief officers should realize that thorough internal and external customer service programs are tied together.

Customer service has secured a permanent place in fire service EMS operations. The customer service program is a section considered for evaluation by the Commission on Ambulance Accreditation Standards and the fire service accreditation process. Feedback from customer service programs as well as how that information is collected, analyzed and processed is required to be documented.

The traditional external customer who dials into the 911 system with a medical emergency is the focus of most public-safety efforts. However, consider all of the other external customers your agency may interact with during a typical day. First, think about how the local nursing home staff views your EMS crews and what kind of customer service rating your agency would receive if sampled. A significant portion of our call volume involves patients in nursing homes or other skilled facilities. Paramedics often perceive them as non-challenging and become frustrated with the information relayed from the staff. Nonetheless, nursing homes and their clients are customers when they call into the 911 system, and despite the frustration, they deserve a professional response.

Second, consider law enforcement's perception of your agency. A survey of the officers in the first-due district and the front-line supervisors should be assessed from a customer service standpoint. In today's environment the communication and teamwork needed between fire, EMS and law enforcement is paramount. Often a survey or just asking the question promotes dialogue and relationships.

Furthermore how is your agency perceived and what kind of customer service is your EMS system delivering to the neighboring EMS or fire agencies? For example, if your fire department provides an ambulance to a neighboring agency for rehab or EMS coverage on the fireground, is the neighboring agency happy with the service and performance in the command structure? Customer service surveys to mutual or automatic aid departments provide an excellent source of information to modify procedures and policies.

Also, how are your crews relating to the local clinics and doctors' offices that occasionally call into the 911 system? An emergency in a doctor's office is a challenge to the staff, and emergency crews often have to bring order to the emotionally charged situation or deal with mundane interfacility transports. The hospital community can provide another assessment of the customer service provided by fire-based EMS. Staff physicians, emergency room nurses and the hospital staff all should be included in a customer service assessment of the fire department paramedics. When the site visit was conducted at our agency by the CAAS team, the evaluators doing the field observation randomly asked nursing staff at the receiving emergency rooms how the paramedics at our agency conducted themselves.

A tactic often used to assess customer service in Fortune 500 companies is the corporate shopper. To get an accurate assessment of what the average customer experiences, a person is sent into the business and orders services or products as any customer would. The difference is the shopper understands key points in the service delivery and is making mental notes on employees' actions. The shopper thoroughly understands the processes the business is delivering and reports back to management to ensure quality service standards are being met.

There are several ways a shopper could be introduced into an EMS system. An EMS unit could be sent in a non-emergency capacity to various minor emergencies and the shopper could assess service delivery. Imagine the impact of a shopper posing as a homeless person. Homeless people make up a significant portion of the customer base in metro areas with a large volume of non-transport calls, which pose a significant risk to EMS systems. However, homeless people often have no means to respond to the fire service's traditional questionnaires or mailers about how we're doing with our service. For that reason, non-transports also should have some method to offer feedback and report on the quality of service. A telephone survey to non-transports to assess their outcomes and where the crew offered an option and follow-up instructions should be a major component to any assessment of a pre-hospital system.

We usually consider a customer as a person outside of the organization. Consider those same statistics and apply them to the internal customers of the department. Firefighters and paramedics out doing the job ought to be supported by management to get the service out to the external customer.

When looking at customer service issues fire chiefs often overlook the root of good customer service, which is having satisfied internal customers. The concept of internal customer service is new to the fire service and it requires a paradigm shift for management to realize that they work for the line paramedic and firefighter by ensuring they have the right tools, knowledge and environment to meet their needs in order to provide excellent service to the public. Three managerial areas to look at when considering internal customer service are training, logistics and fire-rescue operations.

A fire department's training division is the backbone to an internal customer service program and should drive the majority of what is needed by paramedics for excellent customer service. A fire training division should conduct classes in the required certification material to enhance the skills of EMS providers by adding customer-service — related courses. Examples may include communication skills, ethics, material related to quality processes and awareness of diversity issues revolving around the populations we serve. When a fire training division completes its mandated training programs, look to the firefighters and paramedics to provide input on what they feel is important education to add to their skill set.

The logistics division, or the support structure that's responsible for the soft supplies, equipment and vehicles for fire/EMS operations, needs to provide the employees with what they feel is needed to deliver quality care. Fire departments haven't really borrowed the corporate concept of forming quality circles and committees to select equipment and design the work environment.

An EMS equipment committee, with guidelines and education on how to critically evaluate new equipment, can generate innovations and enhancement in customer service. Firefighters and paramedics who use the equipment should have input into the selection and design of vehicles because they will be the ones working out of the back. Applying the committee process to design vehicles also can be considered part of the internal customer service plan.

Lastly, fire rescue operations need to support the internal customer service philosophy by ensuring that managers are available for employees. Managerial support for the EMS staff needs to include finding every opportunity to provide employees with a development path and chance to enhance their skills. Providing feedback on performance, listening and being alert for critical incident stress all fall into the category of internal customer support.

When dealing with external customers, consider what political parties have done in the last few elections. Conduct a town hall meeting in the neighborhoods you serve to facilitate a discussion about the public's expectations of the local fire and EMS services. Also, empower the labor union to participate or organize the department's customer service plan. The IAFF has several resources to guide the labor unit on developing value added service to the delivery in a fire-based EMS system.

Employing an all-encompassing customer service plan that looks at the complete circle of influence the department may have when providing EMS in the community will keep fire-based EMS at the top of the public trust.

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Bruce Evans is the fire science program coordinator at the Community College of Southern Nevada as well as an adjunct faculty member for the National Fire Academy's EMS and injury prevention courses. A captain at the Henderson (Nev.) Fire Department, he has a master's degree in public administration and an associate's degree in fire management.

For more information

Successories — This company has an excellent source of customer service material and several tools to reward employees for excellent customer service; www.successories.com.

Kansas State Firefighters Association — This site provides a link to the Web site that contains a review of Alan Brunacini's Essentials of Fire Department Customer Service; www.ksffa.com/IFSTA/fire_department_customer_service.htm.

Entrepreneur.com — This is a page on a Web site which features several articles and material which discuss internal customer service; www.entrepreneur.com/Your_Business/YB_SegArticle/0,4621,300834,00.html.

HR Solutions — This site provides information on customer service surveys; www.hrsolutionsinc.com.